Perineal and posterior vaginal wall reconstruction with superior and inferior gluteal artery perforator flaps

Abstract

Perineal and posterior vaginal wall reconstruction following abdominoperineal and local cancer resection entails replacement of volume between the perineum and sacrum and restoration of a functional vagina. Ideal local reconstructive options include those which avoid functional muscle sacrifice, do not interfere with colostomy formation, and avoid the use of irradiated tissue. In avoiding the donor site morbidity of other options, we describe a fasciocutaneous option for the reconstruction of the perineum and posterior vaginal wall. We present our technique of superior and inferior gluteal artery perforator (SGAP or IGAP) flaps to reconstruct such defects. Fourteen patients between 2004 and 2008 underwent 11 SGAP and three IGAP flaps. There were no flap failures or partial flap losses and no postoperative hernias. All female patients reported resumption of sexual intercourse following this procedure. Our experience in both the immediate and delayed setting is that this technique produces a good functional outcome with low donor-site morbidity.

Superior and inferior gluteal artery perforator flaps in reconstruction of gluteal and perianal/perineal hidradenitis suppurativa lesions

“…19,20 Pedicled gluteal artery perforator flaps have been described for reconstruction of sacral and ischial pressure sores, 21,22 lumbosacral defects. 23 Wagstaff et al 24 have used gluteal perforator flaps in perineal and vaginal reconstruction successfully.…”

Posterior vaginal wall reconstruction: An easy and reliable solution

“…To overcome this problem, different perforator flaps based on the superior (SGAP) and inferior gluteal arteries (IGAP) have been reported. 4 These flaps reduce the morbidity associated with muscle harvest by careful dissection of the perforator vessel.…”

“…4 The perforators in the perineum include perforators of the superficial external pudendal Figure 1 Perforators from the posterior labial artery were mapped at the lateral base of the labium majora (x in Figure 1). Two labial flaps were designed based on these perforators excluding the border of the labial majora.…”

Reconstruction of Perineum and Abdominal Wall

“…When considering donor site morbidity after harvesting the gluteus maximus muscle, muscle-sparing techniques are the procedure of choice. Flaps in the gluteal area can be harvested based on perforators of the superior (S-GAP) or inferior (I-GAP) gluteal vascular pedicle (Wagstaff et al, 2009). Because of an advantageous arc of rotation, the inferior gluteal artery perforator-based flap can be used to address large sacral and perineal defects (Fig.…”